Quality of documentation is harder to quantify and incentivise, but it has a significant impact on patient care. Good discharge summaries facilitate continuity between secondary and primary care.The junior doctors’ forum led this project to improve the quality of electronic discharge summaries (eDS). Baseline measurement revealed significant room for improvement. We measured the quality of 10 summaries per month (across all inpatient specialties), against 23 indicators from the revised Academy of Medical Royal Colleges (AoMRC) standards (2013) that were prioritised by GPs as a “minimum dataset”.Junior doctors felt that the Trust's dual eDS systems were responsible for great variation in quality. This was confirmed by the results of a comparison audit of the systems in April 2014: one system greatly outperformed the other (57% mean compliance with iSoft clinical management (iCM) based system vs. 77% with InfoPath-based system).We recommended that the Trust move to a single eDS system, decommissioning the iCM-based system, and this proposal was approved by several Trust committees. We worked with information services, junior doctors, general practitioners and hospital physicians to develop and implement a generic template to further improve compliance with AoMRC standards.In August 2014, the iCM-based system was withdrawn, the new template went live, and training was delivered, coinciding with the changeover of junior doctors to minimise disruption. Median compliance increased from 66.7% to 77.8%. Quality of discharge summaries had improved across the specialties. There was a reduction in the number of complaints and positive qualitative feedback from general practitioners and junior doctors. Completion of discharge summaries within 24 hours was not affected by this change.There is still more to be done to improve quality; average compliance with the full AoMRC standards (39 indicators) is 59.5%. With the approval of the Trust executive committee further plan, do, study, act (PDSA) cycles are underway, working to improve the remaining specialty-specific templates.

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Introduction There are multiple drivers to move healthcare into community settings, including people’s own homes. Traditional healthcare training, particularly medical training, is largely hospital-based, and hospital-based models of care. Few professions have explicit training in how best to assess an individual at home, and the additional elements to examine when visiting an induvial in their own home. To meet this training need Croydon Health Services were successful in a bid for funding to develop training to meet this gap. With this funding, a programme was developed and after attempts at simulation home visits in the simulation centre, a virtual reality (VR) home visit scenario was devised and filmed in the community using a professional actor to simulate a housebound individual. The recording was then professionally edited by a specialist VR team to maximise its effectiveness including interactive educational elements. Methods A pilot study examining the acceptability of the virtual reality home visit scenario was designed. A user group of medical staff with limited community experience participated in undertaking the virtual reality scenarios, delivered via Samsung Note 8 devices combined with Samsung Gear VR headsets. Feedback was received from participants by standardised paper-based surveys. Results 7 responses were obtained. 100% of respondents described the scenario as easy to use, as well as agreeing that the same experience could not be gained from watching a standard video of the same scenario. 100% of respondents felt that the on-screen information was helpful. Feedback on areas for improvement suggested a desire for greater interactivity of other aspects of home assessment, and a desire to improve interactivity with the simulated patient, including history taking. Conclusions Virtual reality home visit simulations are an acceptable and effective tool to introduce new concepts to staff. Further development should aim to maximise interactivity in the scenario and explore options for greater interaction with the simulated patient. Further role out of the virtual reality is planned for local and regional training sessions.

Background: Assessing patient-reported outcomes (PROs) is an important element of treatment and care of cancer patients with brain metastases (BMs). BMs are associated with substantial morbidity and mortality. Few prospective studies on PROs in patients with BMs exist. Further, poor accrual, differential dropout, missing data, timing of assessments, and response shift complicate interpretation of PROs in previous studies. We conducted a prospective, population-based study with clinical data and PROs to gain insight into the health-related quality of life (HRQOL) of patients with BMs.